EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion

Meier, Bernhard; Blaauw, Yuri; Khattab, Ahmed A.; Lewalter, T.; Sievert, Horst; Tondo, Claudio; Glikson, Michael

doi:10.1093/europace/euu174

Cited by 270 publications

(172 citation statements)

References 114 publications

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“…Precise knowledge of LAA anatomy and dimensions has become a key guiding stage before implanting LAA closure devices [7, 9–13, 24]. Bedside RT3DTEE measurements of LAA maximal orifice diameter were shown to be more accurate than 2DTEE and are as accurate as CT as the gold standard [16].…”

Section: Discussionmentioning

confidence: 99%

“…Accurate knowledge of LAA anatomy and dimensions has become a key guiding stage before introducing LAA closure devices [7, 9, 10]. LAA assessment should be done prior to procedure [7, 11–13].…”

Section: Introductionmentioning

confidence: 99%

“…LAA assessment should be done prior to procedure [7, 11–13]. Currently, 2D transesophageal echocardiography (2DTEE) at a cut plane angulation of 135° is the recommended method to size maximal LAA orifice diameter before introducing a percutaneous LAA closure device [9, 10, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

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Rotational method simplifies 3-dimensional measurement of left atrial appendage dimensions during transesophageal echocardiography

Yosefy

Azhibekov

Brodkin

et al. 2015

Cardiovasc Ultrasound

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BackgroundNot all echo laboratories have the capability of measuring direct online 3D images, but do have the capability of turning 3D images into 2D ones “online” for bedside measurements. Thus, we hypothesized that a simple and rapid rotation of the sagittal view (green box, x-plane) that shows all needed left atrial appendage (LAA) number of lobes, orifice area, maximal and minimal diameters and depth parameters on the 3D transesophageal echocardiography (3DTEE) image and LAA measurements after turning the images into 2D (Rotational 3DTEE/“Yosefy Rotation”) is as accurate as the direct measurement on real-time-3D image (RT3DTEE).MethodsWe prospectively studied 41 consecutive patients who underwent a routine TEE exam, using QLAB 10 Application on EPIQ7 and IE33 3D-Echo machine (BORTHEL Phillips) between 01/2013 and 12/2015. All patients underwent 64-slice CT before pulmonary vein isolation or for workup of pulmonary embolism. LAA measurements were compared between RT3DTEE and Rotational 3DTEE versus CT. ResultsRotational 3DTEE measurements of LAA were not statistically different from RT3DTEE and from CT regarding: number of lobes (1.6 ± 0.7, 1.6 ± 0.6, and 1.4 ± 0.6, respectively, p = NS for all); internal area of orifice (3.1 ± 0.6, 3.0 ± 0.7, and 3.3 ± 1.5 cm2, respectively, p = NS for all); maximal LAA diameter (24.8 ± 4.5, 24.6 ± 5.0, and 24.9 ± 5.8 mm, respectively, p = NS for all); minimal LAA diameter (16.4 ± 3.4, 16.7 ± 3.3, and 17.0 ± 4.4 mm, respectively, p = NS for all), and LAA depth (20.0 ± 2.1, 19.8 ± 2.2, and 21.7 ± 6.9 mm, respectively, p = NS for all).ConclusionRotational 3DTEE method for assessing LAA is a simple, rapid and feasible method that has accuracy similar to that of RT3DTEE and CT. Thus, rotational 3DTEE (“Yosefy rotation”) may facilitate LAA closure procedure by choosing the appropriate device size.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rotational method simplifies 3-dimensional measurement of left atrial appendage dimensions during transesophageal echocardiography

Yosefy

Azhibekov

Brodkin

et al. 2015

Cardiovasc Ultrasound

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“…thrombocytopenia, cancer), irreversibly high risk of bleeding according to the HAS-BLED score, and the presence of ICS despite OAC treatment [14]. The mean HAS-BLED score was 3.3 ± 0.9.…”

Section: Methodsmentioning

confidence: 99%

Two-dimensional versus three-dimensional transesophageal echocardiography in percutaneous left atrial appendage occlusion

et al. 2020

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“…11 One of the earliest more comprehensive pieces of information studied the results of multiple investigations from various which identified the role of the LAA in the pathophysiology of stroke. [12][13][14] Based on echocardiography and autopsy studies in patients with nonvalvular AF, 90% of strokes appeared to be the result of thrombus in the LAA 12 ( Figure 1). This may be related to inflammation and fibrosis of the wall of the LAA, as well as the specific anatomy of the pectinate muscles.…”

mentioning

confidence: 99%

Left Atrial Appendage and Closure

Holmes

Reddy

2016

Circ: Cardiovascular Interventions

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Abstract-Patients with nonvalvular atrial fibrillation have a 4-to 5-fold increase in strokes and that rhythm may be responsible for 15% to 20% of all strokes, particularly in the elderly. In this setting, thrombus in the left atrial appendage has been found to be the source of stroke in 90% of cases. Although oral anticoagulants have been found effective in reducing stroke rates, for a variety of issues, they may only be used in 40% to 50% of patients at increased risk for stroke. Given pathophysiology of stroke, site-specific therapy directed at left atrial appendage occlusion has been now studied for stroke prevention, and one device is FDA approved (Watchman). A meta-analysis of 2 randomized clinical trials and 2 registries with this device documented the following: (1) patients receiving the device had significantly fewer hemorrhagic strokes (hazard ratio 0.22, P=0.004); (2) a significant reduction in cardiovascular or unexplained death (hazard ratio 0.48, P=0.004); (3) more ischemic strokes in the device group; however, when periprocedural events were excluded, the difference was not significant; and (4) a significant reduction in nonprocedural bleeding with the device (hazard ratio 0.51, P=0.006) versus control. At present, the only device approved in the United States is indicated in patients with nonvalvular atrial fibrillation with acceptable anatomy who are at increased risk for stroke and would be candidates for anticoagulation in whom there is concern about the risk/benefit ratio for chronic anticoagulation. Unresolved issues include optimal patient selection criteria, the role of devices in patients in whom anticoagulation is contraindicated, and the relative role of novel oral anticoagulants versus the device which has not been tested in randomized trials. (Circ Cardiovasc Interv. 2016;9:e002942.

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EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion

Cited by 270 publications

References 114 publications

Rotational method simplifies 3-dimensional measurement of left atrial appendage dimensions during transesophageal echocardiography

Rotational method simplifies 3-dimensional measurement of left atrial appendage dimensions during transesophageal echocardiography

Two-dimensional versus three-dimensional transesophageal echocardiography in percutaneous left atrial appendage occlusion

Left Atrial Appendage and Closure

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